Interdisciplinary Chronic Pain Rehabilitation Program Modifications for Covid-19: Preliminary Evidence Regarding Dosage and Telemedicine

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Authors: David S Cates, Jerry V Walker III, and Valerie K Shostrom
Page Range: 97-108
Published in: Journal of Pain Management, 15#2 (2022)
ISSN: 1939-5914

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Table of Contents

ABSTRACT

Patients with chronic pain may be disproportionately impacted by the COVID-19 pandemic due, in part, to shared risk factors for both chronic pain and COVID-19 infection. At the same time, the pandemic has increased barriers to participating in interdisciplinary chronic pain rehabilitation programs (ICPRPs). The present study provides preliminary evidence regarding the effects of two ICPRP modifications—reduced program dosage and delivery via telemedicine—designed to increase access during the initial COVID-19 surge but with implications beyond the pandemic. Design: Retrospective cohort comparison evaluating pain severity, pain interference, and beliefs relating pain and disability for groups completing 4-week (110-hour) versus 3-week (73-hour) and in-person versus telemedicine ICPRP formats. Subjects: 103 patients who completed an ICPRP at an academic medical center between April 2019 and July 2021. Results: The 4-week, in person; 3-week, in-person; and 3-week, telemedicine programs were all effective in decreasing pain severity, pain interference, and beliefs relating pain and disability. Compared to the 4-week, in-person version, however, the 3-week, in-person program proved less effective in reducing pain interference and beliefs equating pain with impairment. The 3-week, telemedicine format, in turn, was less effective than the 3-week, in-person version in decreasing beliefs associating pain and disability. Conclusions: Decreasing program dosage and offering participation via telemedicine may be viable strategies for increasing access to ICPRPs, but may result in reduced program effectiveness in certain domains. The study’s uncontrolled design and small telemedicine group underscore the need for randomized, controlled trials comparing different ICPRP dosages and modalities.

Keywords: Chronic pain, rehabilitation, pain management, telehealth